Frequent use of the ER fell after the Affordable Care Act

June 12, 2018, University of California, San Francisco

The odds of being a frequent user of California's emergency departments dropped in the two years following the implementation of major provisions of the Affordable Care Act (ACA) in January 2014, according to a new study led by UC San Francisco.

In a -records study of nearly 14 million who visited a California emergency department (ED) at least once from 2012 to 2015—involving 24.5 million visits—the researchers found that the odds of being a frequent ED user declined for patients on Medicaid and the uninsured after the ACA implementation.

Overall, 6.6 million patients visited a California emergency department in the two years prior to the ACA and 7.1 million visited an ED in the two years following it. In 2012-2013, nearly 7.9 percent of those, or 522,576 patients, were frequent visitors, commonly defined as those who visit at least four times per year. After Medicaid and other coverage was expanded, those numbers rose to 8.5 percent, or 604,376 patients, in 2014-2015. Frequent users were responsible for 30.7 percent of all visits before the legislation and 31.6 percent after coverage was expanded.

This increase, however, does not account for the fact that many more people were covered by Medicaid over this time period. When the researchers controlled for the increase in Medicaid coverage and other insurance changes, they found that Medicaid and uninsured patients had 0.88 and 0.69 times the odds of being a frequent ED user, respectively, after the ACA implementation (2014-2015), compared to the pre-ACA period (2012-2013). Privately insured patients experienced little change in the frequency of their visits.

The finding suggests that the nation's largest expansion of health insurance in more than 50 years may have led to improved access to health care services, reducing the need to use emergency departments as a primary source of care, particularly among people served by public insurance programs.

"Our findings do not necessarily suggest that the ACA caused a decrease in frequent emergency department use among Medicaid and uninsured patients, but rather provides evidence that expanded Medicaid coverage might have allowed these patients to access services for serious health conditions outside of the ED," said senior author Renee Hsia, MD, MSc, a UCSF professor of emergency medicine and health policy and a core faculty member in the UCSF Philip R. Lee Institute for Health Policy Studies.

"Efforts to address frequent ED use should take into account Medicaid managed care plans and coordinated mechanisms that provide physical and behavioral health resources across networks," Hsia said.

Frequent use of the often serves as a marker for poor access to non-emergency medical care. Uninsured frequent ED use also is a significant driver in health care costs.

Before the ACA, nearly 27 percent of California's total ED patients were uninsured and frequently had the cost of their care written off by hospitals as charity care. After coverage was expanded, that number halved to 13.2 percent. Among frequent users, represented 29 percent of the total before the ACA and only 8.3 percent after, as Medicaid coverage of the frequent-user population expanded from 44.6 percent to 67.6 percent.

The study is published in Health Affairs.

Most studies of frequent ED use were conducted before 2014, when several major provisions of the ACA were implemented. Under the legislation, some 20 million adults gained health insurance coverage, primarily through expansion of Medicaid eligibility, as well as new insurance marketplaces and subsidies.

In 2017, there were 29.3 million people nationally without health insurance, down from 48.6 million in 2010, according to the Centers for Disease Control and Prevention.

The new study controlled for factors such as health status, primary insurance coverage sources and counties of residence. In addition to , other patient characteristics—including race or ethnicity and health condition—were significantly associated with frequent ED use during the study period, the researchers found. Diagnoses of a mental health condition or substance use disorder were the largest predictors of frequent ED use, with mentally ill patients having at least twice the odds. Non-Hispanic blacks also had 1.27 times the odds than non-Hispanic whites to be a frequent ED user.

Explore further: Medicaid expansion ups access to rehab in young adults with injury

More information: Shannon McConville et al. Frequent Emergency Department Users: A Statewide Comparison Before And After Affordable Care Act Implementation, Health Affairs (2018). DOI: 10.1377/hlthaff.2017.0784

Related Stories

Medicaid expansion ups access to rehab in young adults with injury

June 9, 2018
(HealthDay)—For young adults hospitalized for injury, the first year of implementation of Medicaid expansion under the Affordable Care Act correlated with significant increases in Medicaid coverage, reductions in lack of ...

Affordable Care Act expands health coverage to more patients, although differences remain

September 12, 2017
Expansion of Medicaid coverage under the Affordable Care Act has contributed to sizeable decreases in medical visits in which people were uninsured. This is true across all racial and ethnic groups, although disparities remain.

Medicaid expansion states saw ER visits go up, uninsured ER visits go down

June 19, 2017
States that expanded Medicaid coverage under the Affordable Care Act (the ACA) saw 2.5 emergency department visits more per 1,000 people after 2014, while the share of emergency department visits by the uninsured decreased ...

Does the affordable care act impact patient visits in the emergency department?

July 24, 2017
As the debate surrounding the Affordable Care Act (ACA) looms in the U.S. Congress, Johns Hopkins researchers are weighing in on one aspect of the law. In 2014, as part of the ACA, Maryland was one of the states that expanded ...

Study finds uninsured don't use emergency rooms more than other patients

December 12, 2017
One of the most common arguments for expanding publicly subsidized health coverage is that the uninsured overuse and overburden emergency departments. This argument persists despite evidence that, when the uninsured gain ...

Study finds Medicaid expansion did not increase emergency department use

August 9, 2016
George Washington University (GW) researchers published a Health Affairs study finding that the expansion of Medicaid insurance coverage in the Patient Protection and Affordable Care Act (ACA) did not increase hospital emergency ...

Recommended for you

Students more likely to eat school breakfast when given extra time, new study finds

August 18, 2018
Primary school students are more likely to eat a nutritional breakfast when given 10 extra minutes to do so, according to a new study by researchers at Virginia Tech and Georgia Southern University.

Like shark attack and the lottery, unconscious bias influences cancer screening

August 17, 2018
What do shark attack, the lottery and ovarian cancer screening having in common? It turns out our judgments about these things are all influenced by unconscious bias.

Phantom odors: One American in 15 smells odors that aren't there, study finds

August 16, 2018
Imagine the foul smell of an ash tray or burning hair. Now imagine if these kinds of smells were present in your life, but without a source. A new study finds that 1 in 15 Americans (or 6.5 percent) over the age of 40 experiences ...

US drug overdose deaths surge amid fentanyl scourge

August 16, 2018
US drug overdose deaths surged to nearly 72,000 last year, as addicts increasingly turn to extremely powerful synthetic opioid fentanyl as the supply of prescription painkillers has tightened.

Parental life span predicts daughters living to 90 without chronic disease or disability

August 15, 2018
Researchers at the University of California San Diego School of Medicine report that women whose mothers lived to at least age 90 were more likely to also live to 90, free of serious diseases and disabilities.

Eating breakfast burns more carbs during exercise and accelerates metabolism for next meal

August 15, 2018
Eating breakfast before exercise may "prime" the body to burn carbohydrates during exercise and more rapidly digest food after working out, University of Bath researchers have found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.